C10017210 / invoice 10000

Appointment Reason: Surgery, Appointment Notes: Confirmed Incisional biopsy Reminder text sent + Prep and admit form bxEstimate: $1112.50Medications: NilFasted:  YesDoes your pet have any food allergies or requirements? NilPAI bloods: NoExtras: NilConsent in case of GA complications: YesContact: 0411689157KEEmla applied on arrival Pre-med exam:   BAR nervous HR 140 grade 2 LHS systolic murmur - preexisting but now persistent RR panting, lung fields sound okay all 4 quadrants CRT <2 MM pink moist FP S&SAbdomen soft relaxed 4cm raised subdermal mass ES called Zina to discuss persistent heart murmur. Recommend work up prior to GA as informs our anaesthetic management and planning. Mrs agrees, outlined VN echo vs JR in house La:AO and thoracic rads. Mrs opted for in house w JR. Pre - GA bloods: no JR POCUS, LaAO and chest rads at 10Needs methadone if continuing with incisional biopsyJR: Attempted LA:Ao multiple times, in standing and in lateral on cardiac table. Unable to get optimal view for La:Ao measurement. Impression is that LA is normal and not enlarged, however overlying rib obscures free atrial wall. ONce anaesthetised, Best view is La:Ao of 1.12:1 3 view chest rads - VHS is 9.5, pulmonary a & v same size. No signs pumonary effusion. No metastases apparent in any views Assessment: Suspect stage B1 MMVD and no indication for pimobendan at present. Proceed with GA and lump removal. Recommend repeat (ideally full echo) in 6-12 months as a smaller footprint cardiac probe will improve image acquisition to assess for progression to B2. Induce with     ml alfaxan, place ET tube and maintain on iso/O2.  IV fluids at  25  ml/hr throughout Procedure: Explore and excisional or incisional biopsy w STMass is subdermal, not attached to skin 2cm x 4.5cm superficially, larger when skin reflected.  Incised over tumour at cranial aspect  of LHL at mid tibia. Blunt dissected around mass to distal and lateral extent. Mass involves entire muscle belly of cranial tibialis, with poorly defined margins, haemorrhagic cavitations, and continuing cranially towards stifle. Unable to resect with good margins, concern reflexion of tarsus without muscle.  Took 1-2cmsq tissue sample for histopathology. Significant bleeding of mass. Closed muscle w 3/0 monoplus interrupteds, SC w 3/0 monosyn interrupteds, and skin w 3/0 daffilon cruciate. Applied primapore bandage GA monitoring - BP, SpO2, HR, RR and temp monitored throughout Active warming during GA GA complications and actions: noneWoke up well, recovered on bair hugger and heat mats.  Gave 0.2mL methadone IV as 2.50pm as due Meloxicam 0.4mL SC on recovery given ES called Mrs and no answer - LVM regarding incisional biopsy and pain relief and cone. Reception to go through if O doesn't call back before ES leaves. Mrs called back and we discussed all above. Ok with plan, pick up 5.30pmTo go home on  0.65mL SID 7d starting tomorrowCone on Recheck 10-14d - book 15 mins and talk about heart disease in more detail Call with histopathology results No heart medications required    Vital Signs    Weight: 10.2;